Swelling Case

PROCEDURE: The patient was placed in the supine position on the operating room table, where her right hand and forearm were prepped with Betadine and draped in a sterile fashion. We infiltrated the thenar crease area with 1% Xylocaine, and once adequate anesthesia had been achieved, we exsanguinated the hand and forearm with an Esmarch bandage. We then created a longitudinal incision just at the ulnar aspect of the thenar crease and carried the dissection down through the subcutaneous tissue. We identified the transverse carpal ligament and incised this

Some of the injuries that can occur in the hand are Cubital Tunnel Syndrome and Carpal Tunnel Syndrome along with many more. Cubital Tunnel Syndrome causes pain or numbness in the ring and little fingers, but could also go to the arm (Types of RSI, 2010). Occurs when the ulnar nerve is pinched along the elbow’s edge (“funny bone”), and has tingling or painful feeling (Types of RSI, 2010). Cubital Tunnel Syndrome can be treated by avoiding putting pressure on the “funny bone” (Types of RSI, 2010). Cubital could lead to surgery if the nerve needs to be relieved. Carpal Tunnel Syndrome is similar to Cubital but occurs in the three first fingers. A major nerve is compressed which passes over the carpal bones through the front of the wrist (ASSH, 2015). When the nerve is compressed it causes painful, tingling and numbness in the first three fingers (ASSH, 2015). Carpal Tunnel Syndrome can be treated without surgery by changing the patterns of hand use and/or wearing wrist splints at night (ASSH, 2015). If severe then surgery can take place to make the nerve have more

Patient is a 57-year-old male fuel tank driver who sustained cumulative trauma on 2/7/2004 due to repetitive movement caused by delivering fuel. As per QME dated 1/25/14, the patient has numbness in the fingers and the patient is diagnoses that he has carpal tunnel syndrome. The left wrist had undergone carpal tunnel surgery; however, he gets numbness from the wrist up into his forearm and numbness in the fingertips. It was also noted that on 12/5/13, the patient complains of shoulder pain bilaterally at 7/10. It is constant and goes into noth arms, along with weakness with numbness in the hands, decreased ability to perform activities of daily living, and impared grip. The pain in the bilateral shoulders is constant and aching with intermittent

who had a complication with a tendon in the finger. I witnessed the progression of

DOI: 10/3/2013. Patient is a 51-year-old male bottling machine operator who sustained injury to his left knee when he hit it on an L-bracket after he stepped over a conveyor belt, missed a stool, and fell over. The patient underwent a left knee arthroscopy on 3/31/14.

DOI: 06/04/2008. The patient is a 61-year-old female dispatcher who sustained a work-related injury to her right hand and arm due to repetitive duties. As per OMNI entry, she is status post right proximal median nerve decompression on 05/12/11 and right carpal tunnel release on 09/26/11.

The patient notes that the injury happen when he was lifting some metal trash trays into a trash bin when he felt a sharp pain in his shoulders. Treatment history notes that the treatment to date has consisted of medications. Of note, the MRI done showed a large full thickness tear with retraction of the tendon. Physical examination of the left shoulder revealed that the range of motion has forward flexion of 0-175 degrees, external rotation of 0-40 degrees, and internal rotation to T12. There is positive Hawkins’ and Neer’s sign for impingement. There is weakness with abduction testing. Treatment plan notes recommendation, surgical intervention in the form of a left shoulder, subacromial decompression, rotator cuff repair surgery as necessary. A follow up of 2 to 3 weeks if surgery is authorized. As per medical summary and work status dated 6/14/16, it was noted that the patient has not improved significantly and would be needing surgery. The patient’s return to work date is 6/14/16 with no lifting over 10 pounds and no overhead reach. Follow up to clinic date is on

DOI: 6/23/2016. Patient is a 42-year-old female registered nurse who sustained injury to her neck/left shoulder when she twisted to keep the attachment from falling to the floor. Per OMNI, she was initially diagnosed with strain to multiple body parts.

DOI: 12/23/2013. The patient is a 64-year-old male foreman who sustained injury when he was involved in a motor vehicular accident. Per OMNI, he has had multiple injuries to the right shoulder, right knee, back and right arm/elbow. He is status post arthroscopic surgery for the right shoulder on 05/30/2014.

DOI: 9/30/2014. Patient is a 28-year-old female research assistant who alleges pain and weakness in her hands/wrist as a result of repetitive scooping dirt from soil barrels. As per OMNI entry, the patient was diagnosed with cervicobrachial syndrome (diffuse), right carpal tunnel syndrome and insomnia. She is status post endoscopic carpal tunnel release (CTR) on 09/24/2015 for the right and on 06/02/2015 for the left side.

DOI: 2/25/2014. Patient is a 23 year-old male laborer who sustained a work-related injury to his right hand index finger, middle finger, and ring finger when they got caught in the mixer paddle. As per OMNI entry, the patient underwent open reduction fixation on 3/4/2014 and another surgery for removal of pins, skin graft, and debridement on 06/2013.

DOI: 10/17/2012. Patient is a 54-year-old male janitor who sustained injury while emptying water out of bucket after mopping when he struck his right knee on a metal mop ringer. Per OMNI, he was initially diagnosed with right knee contusion.

HISTORY OF PRESENT ILLNESS: Brandon is a right hand dominant trailer manufacture worker who has been off work since his injury, who injured his right dominant hand seven weeks ago when he caught it between a heavy TV set he was carrying at home and the wall, sustaining a painful deformity of the right hand. That treatment consisted of a closed reduction of the fourth and fifth metacarpal bases done by Jake Heiney, MD. The patient had a benign post-operative course and was recovering uneventfully. His records were reviewed for this visit. He reports no complaints of pain or swelling. No neurovascular or muscular changes. He feels much better overall. No pain at all with most activity. Occasionally sore when he has used it a lot.

Based on the medical report dated 06/27/16, the patient developed bilateral carpal tunnel syndrome over the past year and also some left lateral elbow soreness. Symptoms have progressed. She continues to perform regular work; some adjustments have been made to her work site and she takes short breaks. She takes ibuprofen tablets as needed. Her symptoms wake her from sleep despite night splinting. Of note, electrodiagnostic testing was consistent with moderate to severe bilateral carpal tunnel syndrome. The right side is equal

Diagnosis is confirmed by X-ray of the wrist. This is important to understand the extent of the injury. A posterior-anterior (PA), lateral, and oblique radiographs of the distal radius that include the carpal bones should be obtained. All three radiographs should be examined for a loss of normal anatomy, disruption of the articular surface, involvement of the distal radio-ulnar and radiocarpal joints, and evidence of comminution (Villet 2011).